Assembly Health Budget Update April 2014
April 24, 2014

Dear Friend:

On Monday, March 31, the Legislature passed the State budget for 2014-15. As Chair of the Assembly Health Committee, I want to let you know about a few of the many important achievements this year. Contrary to press reports, the budget process is not just "three men in a room." Most of it is hard work by legislators, staff, advocates, and the community that can lead to real progress on major issues. Here are some examples:

Basic Health Program: Many New Yorkers have incomes too high to qualify for Medicaid but too low to afford commercial insurance, even with Affordable Care Act federal subsidies. The ACA authorizes states to provide health insurance coverage - called the Basic Health Program (BHP) - to these individuals between 133% and 200% of the poverty level, with the state paying the patient's share of the premium not covered by the federal subsidy. I've been the legislative voice pushing this in Albany. With the strong and constant advocacy of the Community Service Society, I was able to get the Governor, the Assembly and the Senate to include it in the budget. BHP will provide health coverage to hundreds of thousands of people. Also, New York State now provides state-funded Medicaid to many immigrants, without any federal support. But under the Basic Health Program, we will now get federal funds for that group. So the BHP will actually bring New York several hundred million dollars a year.

"Aid Continuing": "Aid continuing" is a Medicaid rule that protects a patient when Medicaid proposes to cut a service. The service continues while the person pursues appeals of eligibility or service denials or changes. It is a critical issue especially for frail elderly and people with disabilities who receive home health care. But if a service was approved for a particular period and is cut for the next period, the state has argued this means there is nothing to "continue". I worked for two years to get a law passed to correct this, in partnership with several advocacy groups, and was able to get it included in the budget in the final hours of negotiation.

Out-of-Network Health Coverage: Too often, New Yorkers are hit with surprise medical bills from providers who turn out not to have been in their insurance plan's network. I have sponsored an out-of-network protection bill for several years. This year, the Governor put language similar to my bill in his budget proposal, and with some modifications it was enacted. It protects patients by requiring reasonable notice if their doctor is out-of-network, limits co-pays for "surprise" and out-of-network emergency care, and sets up an arbitration process for setting rates for out-of-network care. It's an important package. But it does not solve all the problems with limited health plan networks, and it does not apply at all to the "self-insured" plans used by many large employers (federal law bars us from regulating them). The real solution will be to enact my "New York Health" single-payer health plan.

Nurse Practitioners: Nurse practitioners (NPs) play an increasingly vital role in our health care delivery system. This year's budget allows an NP with about 3 years experience to practice without the outdated and onerous requirement of a written collaborative agreement with a physicians. Instead, they will have a collaborative relationship with a physician or hospital. I had sponsored this legislation for several years.

Corporate Ownership of Hospitals: For the second consecutive year, the Governor proposed allowing large for-profit corporations to own hospitals. The Senate supported this. But I led the successful fight to reject this plan. Corporate ownership is not the answer for New York hospitals.

The 2014-15 budget process was a success in many ways. While some issues, including allowing medical use of marijuana, will have to be pursued after the budget, we won a number of victories in expanding access to care and protecting patients. With your support, I will continue working with the community, health care providers, advocates for patients, and my colleagues in the legislature to improve our health care system for all New Yorkers.

Very truly yours,
Richard N. Gottfried
Assembly Member